Control No.: P-693/09-2017 Requesting country: The United States of America File No.: 2017/202335-1 Date of publication: 13/09/2017 MODUS OPERANDI FENTANYL RISE IN USE, OVERDOSE, AND EXPOSURE TO AN OPIOID PRESENTING A LETHAL RISK FOR CONSUMERS, LAW ENFORCEMENT, AND FIRST RESPONDERS Date of the offence: ONGOING Place of offence: Country of offence: Circumstances of offence: WORLDWIDE WORLDWIDE Fentanyl is a powerful synthetic opioid that mimics the effects of morphine in the human body. Responsible for an epidemic of overdose deaths in the United States, fentanyl can be 50 to 100 times stronger than morphine, and 30 to 50 times more powerful than heroin. Fentanyl and its analogs are being mixed with heroin to increase potency. It is also being pressed into counterfeit tablets and sold as commonly misused prescription opioids such as oxycodone and hydrocodone. In addition, it has been found in samples of cocaine, methamphetamine, and other non-opioid substances. Description of modus operandi: INTERPOL For official use only During the last two years, the distribution of clandestinely manufactured fentanyl has been linked to an unprecedented outbreak of overdoses and deaths numbering in the thousands. In the United States, the U.S. Centers for Disease Control and Prevention says the number of synthetic opioid deaths increased 72.2% from 2014 to 2015. Fentanyl and its analogs pose a potential hazard to police, law enforcement officials, public health workers, and first responders who could unknowingly come into contact with these drugs in their different forms. Police working dogs are also at risk of exposure. Responders are most likely to encounter illicitly manufactured fentanyl and its analogs in powder, tablet, liquid, patches, and spray form. Potential exposure routes of greatest concern include inhalation, mucous membrane contact, ingestion, and percutaneous (needle) exposure. Skin contact is also a potential exposure route but is not likely to lead to overdose unless large volumes of highly concentrated powder are encountered over an extended period. While absorption of fentanyl through skin contact commonly occurs through prescribed use of the drug, inhalation of powder is the most likely exposure route for illicitly manufactured fentanyl. Inhalation exposure can quickly result in respiratory depression. Two to three milligrams of fentanyl an amount equivalent to five to seven grains of table salt is enough to cause respiratory depression, cardiac arrest and possible death. Page 1/5
L Law enforcement personnel may come into contact with these drugs on the street during the course of routine law enforcement, emergency, or life-saving activities. It is recommended that officers do not field test drugs if fentanyl is suspected. Instead, the substance should be collected and sent to a laboratory for analysis First responders must be trained and equipped to recognize the hazard, and know how to put on personal protective equipment (PPE), such as gloves, dust masks, safety glasses, paper suits, and shoe covers. The level of equipment may need to be increased or decreased depending on the situation. It is further recommended that first responders always have naloxone, the opioid overdose antidote, on hand. Immediately administering naloxone can reverse an opioid overdose. In addition, responders should follow established work practices as well as the following recommendations when fentanyl or its analogs are known or suspected to be present. Do not touch the eyes, mouth, and nose after touching any surface potentially contaminated with fentanyl. Field testing of fentanyl or its analogs is not recommended due to an increased risk of exposure to those performing the test. However, if detection and identification of fentanyl is critical to the incident response, an incident-specific plan for field testing should be developed in accordance with agency policies and procedures. Personnel specifically trained to perform the field testing should perform the testing in the appropriate PPE. Never handle fentanyl or its analogues without the appropriate PPE. Avoid performing tasks or operations that may aerosolize fentanyl due to increased exposure risks. Activities that aerosolize fentanyl require higher levels of PPE and should be conducted by appropriately trained personnel and in accordance with agency policies and procedures. Wash hands with soap and water immediately after a potential exposure and after leaving a scene where fentanyl is known or suspected to be present to avoid potential exposure and to avoid cross contamination. Do not use hand sanitizers or bleach solutions to clean contaminated skin. File Nr: 2017/202335-1 Page 2/5 Control Nr: P-693/09-2017
0 Figure 1: Two three milligrams of fentanyl: A potentially lethal dose. Figure 2: Fentanyl in pill form. File Nr: 2017/202335-1 Page 3/5 Control Nr: P-693/09-2017
Figure 3: Fentanyl in powder form. Figure 4: Decontamination procedures: Full Personal Protection Equipment (PPE) File Nr: 2017/202335-1 Page 4/5 Control Nr: P-693/09-2017
ADDITIONAL INFORMATION The risks associated with fentanyl and its analogs highlight the need for first responders to perform a risk assessment on each crime scene; follow established work practices appropriate for the specific job tasking, and wear appropriate-level PPE to effectively manage risks that could result in an exposure. Established work practices are written policies, procedures, tactics, and techniques that can minimize the risk of exposure when fentanyl may be present. The U.S. Drug Enforcement Administration (DEA) has developed a selection of free reference materials for use by law enforcement officers and others who may come into contact with fentanyl in the course of their official duties. Available in English at https://www.dea.gov/druginfo/fentanyl.shtml, these publications provide information on how to identify fentanyl; prevent exposure to it, and respond in the event of an emergency. Points of contact: E-mail: Telephone: Fax: usncb.interpol.washington@usdoj.gov os-ccc@interpol.int (Internet) os-ccc@gs.igcs.int (I-24/7) +1 202-616-3900 + 33 4 72 44 76 76 +1 202 616 8400 + 33 4 72 44 71 63 Recommended precautionary action: It is strongly recommended that you circulate this purple notice to your country s law enforcement bodies to alert them about this modus operandi and to allow them to take whatever preventive and precautionary measures they deem necessary. All recipients are strongly encouraged to share data, and provide any investigative information related. NCB Reference : 20170929798/DHE File Nr: 2017/202335-1 Page 5/5 Control Nr: P-693/09-2017